Adejoke B. Ayoola

Reasons for unprotected intercourse in adult women: a qualitative study.

Despite the focus on adolescents, most unintended pregnancies occur in adults. The objective of this study was to identify reasons why adult women have unprotected intercourse when they do not desire pregnancy. We held 4 focus groups to explore reasons for unprotected intercourse. Participants were adult women aged 18 to 39 who were unmarried, fertile, not currently pregnant, not desiring pregnancy, and who had recently had intercourse without using effective contraception. Sessions were audiotaped and transcripts were analyzed thematically. Women gave 146 reasons for unprotected intercourse. Four major categories emerged: method-related, user-related, partner-related, and cost/access-related reasons. The reasons for unprotected intercourse were numerous, but could be organized into a logical framework. The results suggest that multidimensional interventions may be needed to effectively reduce the rate of unintended pregnancy.

Late recognition of pregnancy as a predictor of adverse birth outcomes.

OBJECTIVE We examined the relationship between the time of recognition of pregnancy and birth outcomes, such as premature births, low birthweight (LBW), admission to the neonatal intensive care unit (NICU), and infant mortality. STUDY DESIGN A secondary analysis was performed using the Pregnancy Risk Assessment and Monitoring System (PRAMS) multistate data from 2000-2004. The sample consisted of 136,373 women who had a live childbirth. Analysis involved multiple logistic regression models, appropriately weighted for point and variance estimation to reflect the complex survey design of the PRAMS using STATA 9.2 (Stata Corp, College Station, TX). RESULTS Approximately 27.6% recognized their pregnancy late (after 6 weeks of gestation). Late recognition was significantly associated with an increased odds of having premature births (odds ratio [OR], 1.09; 99% confidence interval [CI], 1.01-1.19), LBW (OR, 1.08; 99% CI, 1.01-1.15), and NICU admissions (OR, 1.12; 99% CI, 1.03-1.21). CONCLUSION These results provide a rationale and an impetus for developing interventions that promote early recognition of pregnancy.

Time from pregnancy recognition to prenatal care and associated newborn outcomes

OBJECTIVE To examine the relationship between newborn outcomes and late prenatal care initiation after recognition of pregnancy. DESIGN Secondary data analysis of the Pregnancy Risk Assessment and Monitoring System (PRAMS) data for the United States. SETTING Twenty-nine states. PARTICIPANTS Women of childbearing age (135,623) who resided in 29 states in the PRAMS study who received prenatal care and had live births. METHODS Population-based survey from 2000 through 2004 that examined four newborn outcomes: prematurity, low birth weight (LBW), admission into Neonatal Intensive Care Unit (NICU), and infant mortality. RESULTS The average time lag (difference between the time of pregnancy recognition and initiation of prenatal care) for the study was 3.2 weeks (99% CI [3.12, 3.21]). Women who recognized their pregnancies before 6 weeks had a longer lag time (3.5 weeks, 99% CI [3.43, 3.53]) than women who recognized their pregnancies later (2.1 weeks, 99% CI [1.96, 2.15]). After adjusting for confounders including the timing of pregnancy recognition, longer time lag was associated with reduced risks of prematurity (odds ratio [OR]=0.99, 99% Confidence Interval [CI] [0.97, 1.00], p<.01), LBW (OR=0.98, 99% CI [0.97, 0.99], p<.01) and NICU admission (OR=0.99, 99% CI [0.98, 1.00], p<.01) but not with infant mortality (OR=1.00, 99% CI [0.95, 1.05], p>.01). CONCLUSION Average time lag from pregnancy recognition to prenatal care was not associated with poor newborn outcomes once results were adjusted for time of pregnancy recognition and other confounders.

Self-Testing for Pregnancy Among Women at Risk A Randomized Controlled Trial

BACKGROUND The timing of pregnancy recognition affects early pregnancy and the timing of prenatal care. Little research has been done on how to make women at risk more alert to the possibility of pregnancy. DESIGN The study was an RCT performed and analyzed between 2006 and 2007. SETTING/PARTICIPANTS Participants were low-income, adult women who were having unprotected intercourse and were not actively trying to conceive. INTERVENTION Women in the intervention group received a free home-pregnancy test kit and were able to order more kits as needed. Six-month follow-up information was obtained. MAIN OUTCOME MEASURES The main outcome measures were suspicion and testing for pregnancy. RESULTS Ninety-one percent of the 198 participants completed the study. Women in the intervention group suspected pregnancy 2.3 times during the 6-month period compared to 1.2 times for women in the control group (p<0.0001). Women in the intervention group tested for pregnancy 93% of the time when they suspected pregnancy. Women in the control group tested for pregnancy only 64% of the time when they suspected pregnancy (p<0.0001). CONCLUSIONS Women who were having unprotected intercourse were more likely to suspect and test for pregnancy if they were supplied with a free home-pregnancy test kit.

Impact of Integrating Community-Based Participatory Research Into a Baccalaureate Nursing Curriculum

BACKGROUND Community-based participatory research (CBPR) is rapidly gaining respect within the health care community as a means to promote public health and address health disparities. It has also recently been named as one of the competencies needed by public health professionals to be effective. METHOD This article describes an educational innovation where CBPR is integrated into a baccalaureate nursing curriculum as a strategy to create meaningful learning experiences for nursing students while benefitting the health of the community. RESULTS The impact of this approach was analyzed over a period of 12 years. The positive outcomes for the community, students, and faculty are described, along with the unique challenges. CONCLUSION Integrating CBPR into a nursing curriculum is an innovation that is worthy of further assessment.

Research articleSelf-Testing for Pregnancy Among Women at Risk: A Randomized Controlled Trial

BACKGROUND The timing of pregnancy recognition affects early pregnancy and the timing of prenatal care. Little research has been done on how to make women at risk more alert to the possibility of pregnancy. DESIGN The study was an RCT performed and analyzed between 2006 and 2007. SETTING/PARTICIPANTS Participants were low-income, adult women who were having unprotected intercourse and were not actively trying to conceive. INTERVENTION Women in the intervention group received a free home-pregnancy test kit and were able to order more kits as needed. Six-month follow-up information was obtained. MAIN OUTCOME MEASURES The main outcome measures were suspicion and testing for pregnancy. RESULTS Ninety-one percent of the 198 participants completed the study. Women in the intervention group suspected pregnancy 2.3 times during the 6-month period compared to 1.2 times for women in the control group (p<0.0001). Women in the intervention group tested for pregnancy 93% of the time when they suspected pregnancy. Women in the control group tested for pregnancy only 64% of the time when they suspected pregnancy (p<0.0001). CONCLUSIONS Women who were having unprotected intercourse were more likely to suspect and test for pregnancy if they were supplied with a free home-pregnancy test kit.

Reducing the number of antenatal care visits in low-risk pregnancies increases perinatal mortality in low- and middle-income countries; women in all settings prefer the standard visit schedule.

Commentary on: T Dowswell, G Carroli, L Duley, et al.. Alternative versus standard packages of antenatal care for low-risk pregnancy. Cochrane Database Syst Rev2010;10:CD000934.

Conducting Research With Community Groups

Nurse scientists are increasingly recognizing the necessity of conducting research with community groups to effectively address complex health problems and successfully translate scientific advancements into the community. Although several barriers to conducting research with community groups exist, community-based participatory research (CBPR) has the potential to mitigate these barriers. CBPR has been employed in programs of research that respond in culturally sensitive ways to identify community needs and thereby address current health disparities. This article presents case studies that demonstrate how CBPR principles guided the development of (a) a healthy body weight program for urban, underserved African American women; (b) a reproductive health educational intervention for urban, low-income, underserved, ethnically diverse women; and (c) a pilot anxiety/depression intervention for urban, low-income, underserved, ethnically diverse women. These case studies illustrate the potential of CBPR as an orientation to research that can be employed effectively in non-research-intensive academic environments.

Promoting INDIVIDUALIZED Breastfeeding Experiences

AbstractBreastfeeding is beneficial for the baby and the mother, but is yet to be successfully practiced by newly delivered women as proposed in the Healthy People 2020 goal. Most breastfeeding education during the prenatal or postpartum period provides adequate information for interested women. However, mothers need individualized client–professional interactions and follow-up after hospital discharge. This article describes the breastfeeding experiences of two women and the implications for nurses and other healthcare professionals in relation to efforts to promote breastfeeding. Two anecdotal case studies are presented illustrating that even when mothers have resources and education, the breastfeeding education can be frustrating and misunderstood. Nurses can master the skill of closing the feedback loop in breastfeeding education by assessing and clarifying womens interpretation of breastfeeding information they received. This nursing skill can empower mothers to make informed decisions for effective and sustained breastfeeding.

Utilization of Home Pregnancy Testing Among Women at Risk for Unintended Pregnancy

PURPOSE We sought to determine whether a brief intervention increased home pregnancy test utilization among women at risk for unintended pregnancy. METHODS The intervention included education, consultation with a nurse, and the provision of a free home pregnancy test kit. Participants were 35 women aged 18-39 years from a Medicaid population who were having unprotected intercourse and who were not trying to conceive. The women received education on pregnancy testing and the importance of early recognition of pregnancy. All women received a free home pregnancy test kit. The main outcome measures were pregnancy test use and appropriateness of use. MAIN FINDINGS During the 3-month follow-up period, 62% of participants used the home pregnancy test kit, which was approximately 3 times higher than the self-reported testing rate before the study (p < .001). The most common reason for use was a late period (median 5 days late when test was done). Women also purchased additional kits to confirm the initial test result (median 2 kits per episode of use). CONCLUSION The intervention increased utilization of home pregnancy test kits among women at risk of unintended pregnancy. All study participants used the test appropriately. These results can serve as a framework for interventions to improve early pregnancy recognition.